A survey of patients was undertaken to determine their knowledge and understanding of advance statements (a new addition to Scottish mental health legislation introduced with the Mental Health (Care and Treatment) (Scotland) Act 2003). Few patients have taken up this facility and this study attempts to identify potential explanations.

A minority of the initial 58 participants had heard of advance statements prior to the survey (5 of 58, 8.6%). After issuing information about advance statements, awareness and understanding increased significantly among those who completed the study, with 59% (16 of 27) now understanding the concept. The types of information that patients wished to be documented in an advance statement fell into two broad groups: treatment preferences and statements regarding loss of control and autonomy. Out of 27 participants 19 (70%) stated they would now consider drawing up an advance statement.

A lack of knowledge among patients about the existence of advance statements is highlighted. After a brief intervention, awareness, understanding and interest increased significantly, suggesting that poor uptake could be because of lack of awareness. Most participants would consult mental health professionals when drawing up an advance statement, therefore we have a responsibility to be fully informed about the process.

We describe two patients, both diagnosed with psychotic illnesses, who developed stuttering while being treated with clozapine.

In both patients the stuttering was severe and significantly impaired progress towards recovery. Deviant speech dimensions and voice quality were consistent with dysarthria and dystonia.

Patients who develop abnormal electroencephalogram activity and those who have a family or personal history of stuttering might be at increased risk of developing speech problems with clozapine. Speech dysfluency might be a consequence of clozapine's action in lowering the seizure threshold. Potential management strategies include the use of sodium valproate and changing the type of antipsychotic.

The aim of this study was to investigate the pattern of performance of candidates in the MRCPsych examinations in the period 1997–2002 inclusive. During this period 6306 candidates sat the MRCPsych part I and 4536 sat the MRCPsych part II.

The overall pass rates for MRCPsych part I was 44.7% and 48.9% for MRCPsych part II. The majority of those who passed either part of the examinations did so on their first attempt; females performed better than males and graduates of UK and Republic of Ireland medical schools performed better than foreign graduates in all component parts of the examinations.

The pattern of results suggests that clinical tutors and course organisers need to pay special care to the training needs of trainees who are foreign medical graduates.

To review the quality of information and advice contained in correspondence from old age psychiatrists to general practitioners (GPs) regarding the prescription of antipsychotic drugs for the management of behavioural and psychological symptoms of dementia. Discharge summaries (n=22) and subsequent out-patient review letters were examined and compared with evidence-based guidelines in two phases of an audit cycle; first in 2002 and latterly in 2005.

Practice was below acceptable standards during both phases of the audit cycle, with an actual drop in the quality of explicit advice given to GPs in 2005, despite national publicity about the issues and guidance from the Royal College of Psychiatrists.

The prescription of antipsychotic drugs is associated with an adverse prognosis for people with dementia. As such, it is imperative that such treatment is regularly reviewed and time limited. Old age psychiatrists need to ensure that this message is communicated to their primary care colleagues.

In 1999, child and adolescent mental health (CAMH) in-patient provision was unevenly distributed across England. A repeat of a1999 bed count survey was conducted in 2006 to determine whether change had occurred in response to government policy.

Total bed numbers in England were found to have increased by 284; 69% of the increase is due to the independent sector, whose market share has risen from 25% in 1999 to 36% in 2006. Regions with the highest number of beds in 1999 have increased bed numbers more than areas with the lowest number of beds in1999 (8.3 v. 3.6 beds per million population). In units that admit only children under the age of 14, there has been a 30% reduction in beds available (123 to 86).

Inequity in provision of CAMH inpatient services has increased despite government policy to the contrary. We speculate that this might be partly due to fragmented and local commissioning, and the effects of market forces operating as a result of increasing privatisation.

To identify deficits in senior house officer (SHO) on-call experience since the advent of accident and emergency (A&E) liaison nurse cover, by retrospectively examining records of 267 A&E patients between October 2004 and January 2005. We collated our data in terms of presenting symptoms.

The majority (59%) of A&E referrals received no SHO attention. In particular, SHOs had no involvement in 69% of ‘social’ presentations, 72% of presentations involving drug or alcohol misuse and 63% of presentations with associated suicidality, self-harm or overdose.

Clinical experience is being lost in key areas, and is not yet being replaced via other routes. There is a pressing need to consider methods to ensure development of these skills, at the same time as adhering to the European Working Time Directive.

Many studies report prescribing preferences for antipsychotics but few have examined what professionals would choose for themselves if they were diagnosed with schizophrenia. We asked 188 nurses, pharmacists and doctors which antipsychotic they would prefer to be prescribed.

Risperidone (n=49, 26.1%), olanzapine (n=49, 26.1%) and aripiprazole (n=35, 18.6%) were the most popular choices.

Professionals' choice was in line with the latest evidence on comparative effectiveness of atypical antipsychotics and therefore might be a sensitive indicator of the most effective antipsychotic.

To examine patients' views on the quality of care they received before, during and after electroconvulsive therapy (ECT), a questionnaire was completed by 389 patients who had received ECT at ECT Accreditation Service (ECTAS) member clinics.

The nine key standards set by ECTAS relating to quality of patient care were rated as having been met by 65% or more respondents. Most patients found staff friendly and reassuring and often commented on how this had helped reduce their anxiety prior to ECT. Patients were less positive about standards relating to being introduced to staff prior to ECT, and the quality of the waiting and post-recovery areas.

Patient views are important indicators of quality of care and should be used to improve ECT practice. Anxiety about ECT is helped by supportive and caring staff. Improvements could be made to practices related to waiting for and recovering from ECT.

A survey was undertaken to investigate assaults of psychiatrists by patients in a 12-month period. Surveys were sent to 199 psychiatrists representing all sub-specialties and grades in a London mental health trust.

There were 129 returned responses (response rate 64.8%). In the 12-month study period, 12.4% of all psychiatrists and 32.4% of senior house officers were assaulted. None received or took up offers of formal, as opposed to informal, psychological support. Most assaults occurred on a psychiatric ward. Vulnerability to assaults was not influenced by courses on prevention and management of violence or by the attitudes of psychiatrists to violence by psychiatric patients.

Senior house officers are most vulnerable to assaults. Greater attention may need to be given to psychiatric wards where most assaults occurred. Trusts should ensure that those assaulted are identified and offered support.

The lead consultants of all adolescent in-patient psychiatric units in England and Wales were surveyed in 2000 and again in 2005, to determine whether they could admit young people in an emergency.

In 2000, 51 of 64, and in 2005, 70 of 79 units responded. Although the number of units with dedicated ‘emergency admission beds’ had increased from 6 to 16, 34% of the total could never admit as an emergency in 2005 and 44% could never admit out of hours. The consultants estimated that, in 2005, they turned away 72% of referrals for emergency admission. Although 87% of consultants agreed that there should be emergency access to specialist adolescent psychiatric beds, concern was expressed that services are not configured to accept emergency admissions.

This problem is unlikely to be resolved by requiring units to accept both emergency and planned admissions. These groups have very different needs. Coherent and unified commissioning is needed to achieve equity of access to emergency beds, along with separate planned admission units and a range of alternative emergency services.

The aim of the study was to investigate the interrater reliability of the clinical component of the MRCPsych part II examinations, namely the individual patient assessment and the patient management problems. In the study period, there were 1546 candidates and 773 pairs of examiners. Kappa scores for pairs of examiners in both these assessments were calculated.

The kappa scores for exact numerical agreement between the pairs of examiners in both individual patient assessment and patient management problems were only moderate (0.4 –0.5). However, the kappa scores for agreement between pairs of examiners for the reclassified pass and fail categories were very good (0.8).

The poor reliability of the traditional long case and oral examinations in general is one of the most potent arguments against their use. Our finding suggests that the College clinical examinations are at least not problematic from this point of view, particularly if global pass or fail judgements rather than discrete scores are applied.